Rationale: Cerebrovascular diseases (CVD) are a major cause of death and disability. A meta-analy... more Rationale: Cerebrovascular diseases (CVD) are a major cause of death and disability. A meta-analysis found that stroke severity (p Objectives: This study assesses the impact of TIA and stroke, and their severity, by examining the predictors of QoL one-year after the event, including previous QoL, using data from a population-based study. Methodology: Data were obtained from the Oxford Vascular study (OXVASC), a population-based cohort of >90,000 individuals in Oxfordshire, UK. OXVASC identified 284 patients with a first or recurrent CVD event during April 2002, to March 2003. QoL was assessed using the EQ-5D at one-month and one-year after the index event. At one-month, patients were also asked about their QoL before the event (baseline). EQ-5D results were converted into utilities using UK social tariffs, with the analysis only considering the 217 (76%) patients who survived past one-year after event. Stepwise multivariate analyses were performed to identify predictors of one-ye...
To assess UK governmental and charity research funding in 2012 for cancer, coronary heart disease... more To assess UK governmental and charity research funding in 2012 for cancer, coronary heart disease (CHD), dementia and stroke, and to make comparisons with 2008 levels. Analysis of research expenditure. United Kingdom. We identified UK governmental agencies and charities providing health research funding to determine the 2012 levels of funding for cancer, CHD, dementia and stroke. Levels of research funding were compared to burden of disease measures, including prevalence, disability adjusted life years and economic burden. The combined research funding into cancer, CHD, dementia and stroke by governmental and charity organisations in 2012 was £856 million, of which £544 million (64%) was devoted to cancer, £166 million (19%) to CHD, £90 million (11%) to dementia and £56 million (7%) to stroke. For every £10 of health and social care costs attributable to each disease, cancer received £1.08 in research funding, CHD £0.65, stroke £0.19 and dementia £0.08. A considerable shift in the d...
This study examines national health expenditure trends for Japan, Canada, Australia, and England ... more This study examines national health expenditure trends for Japan, Canada, Australia, and England and Wales (combined) to assess the impact of changing demographics and changing age-specific per capita expenditure on national health expenditure. Age-specific expenditure data were obtained from each country's department of health. We calculated changes in age-specific per capita expenditure, population demographics and the share of expenditures used by the different age groups over time. We then determined the extent to which isolated changes in population growth, demographic shifts and changes in age-specific per capita expenditure could predict observed increases in health expenditure. For Japan, Canada and Australia per capita health expenditure increased fastest among those aged 65 and over, at up to twice the increase of those aged 45-64. In England and Wales, on the other hand, those aged 65 and over experienced one-third of the cost increase of those aged 45-64. Hence, the ...
The Journal of the Royal College of General Practitioners, 1981
The roles of general practitioner and specialist maternity units are increasingly being debated w... more The roles of general practitioner and specialist maternity units are increasingly being debated with reference to resources and the need for savings in the NHS. Unfortunately, many of the economic issues involved are frequently misunderstood. On the basis of a study of maternity care in one Health Board area in Scotland, we present an example of the type of economic data which are needed to make policy decisions on resource allocation in hospital maternity care. Differences between the two unit types are presented in terms of their unit costs, their cost structures and their inpatient cost profiles.
The increasing use of thrombolytic therapy following acute myocardial infarction has given rise t... more The increasing use of thrombolytic therapy following acute myocardial infarction has given rise to value for money questions. This study examines the cost-effectiveness of the thrombolytic agent anistreplase (Eminase). Using clinical trial data on the efficacy of anistreplase compared to placebo, and retrospectively obtained cost data from the National Health Service, the study estimates the cost per life-year saved of using this therapeutic agent. The results suggest that the cost-effectiveness of thrombolytic therapy compares favourably with that of other forms of coronary disease treatment. The study concludes that comparisons of the relative cost-effectiveness of different thrombolytic agents are an obvious next step, once full results from recent clinical trials are available.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 5, 2015
It is unclear whether a social gradient in health outcomes exists for people with moderate-to-sev... more It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the 'suitability' of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance an...
Diabetic medicine : a journal of the British Diabetic Association, 2015
To estimate the immediate and long-term inpatient and non-inpatient costs for Type 2 diabetes-rel... more To estimate the immediate and long-term inpatient and non-inpatient costs for Type 2 diabetes-related complications. The costs of all consultations, visits, admissions and procedures associated with diabetes-related complications during UK Prospective Diabetes Study post-trial monitoring in the period 1997-2007 were estimated using hospitalization records for 2791 patients in England and resource use questionnaires that were administered to 3589 patients across the UK. The estimated (95% CI) inpatient care costs (in 2012 pounds sterling) in the event year for the example of a 60-year-old man were: non-fatal ischaemic heart disease £9767 (£7038-£12 696); amputation £9546 (£6416-£13 463); non-fatal stroke £6805 (£3856-£10 278); non-fatal myocardial infarction £6379 (£4290-£8339); fatal stroke £3954 (£2012-£6428); fatal ischaemic heart disease £3766 (£746-£5512); heart failure £3191 (£1678-4903); fatal myocardial infarction £1521 (£647-£2670); and blindness in one eye £1355 (£415-£2655...
We aimed to estimate and externally validate a new UK-specific prognostic model for predicting th... more We aimed to estimate and externally validate a new UK-specific prognostic model for predicting the long-term risk of a first recurrent event (local recurrence, metastatic recurrence, or second primary breast cancer) in women diagnosed with early breast cancer. Using data on the prognostic characteristics and outcomes of 1844 women treated for early breast cancer at the Churchill Hospital in Oxford, parametric regression-based survival analysis was used to estimate a prognostic model for recurrence-free survival. The model, which incorporated established prognostic factors, was externally validated using independent data. Its performance was compared with that of the Nottingham Prognostic Index (NPI) and Adjuvant! Online. The number of positive axillary lymph nodes, tumour grade, tumour size and patient age were strong predictors of recurrence. Oestrogen receptor (ER) positivity was shown to afford a moderate protective effect. The model was able to separate patients into distinct pr...
Adjuvant! Online is an internet-based computer programme providing 10-year prognosis predictions ... more Adjuvant! Online is an internet-based computer programme providing 10-year prognosis predictions for early breast cancer patients. It was developed in the United States, has been successfully validated in Canada, and is used in the United Kingdom and elsewhere. This study investigates the performance of Adjuvant! in a cohort of patients from the United Kingdom. Data on the prognostic factors and management of 1065 women with early breast cancer diagnosed consecutively at the Churchill Hospital in Oxford between 1986 and 1996 were entered into Adjuvant! to generate predictions of overall survival (OS), breast cancer-specific survival (BCSS), and event-free survival (EFS) at 10 years. Such predictions were compared with the observed 10-year outcomes of these patients. For the whole cohort, Adjuvant! significantly overestimated OS (by 5.54%, P<0.001), BCSS (by 4.53%, P<0.001), and EFS (by 3.51%, P=0.001). For OS and BCSS, overestimation persisted across most demographic, patholog...
Health technology assessment (Winchester, England), 2005
To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic ... more To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic CMHN care, against usual general practitioner (GP) care in reducing symptoms, alleviating problems, and improving social functioning and quality of life for people living in the community with common mental disorders; and to undertake a cost comparison of each CMHN treatment compared with usual GP care. A pragmatic, randomised controlled trial with three arms: CMHN problem-solving, generic CMHN care and usual GP care. General practices in two southern English counties were included in the study. CMHNs were employed by local NHS trusts providing community mental health services. Participants were GP patients aged 18--65 years with a new episode of anxiety, depression or reaction to life difficulties and had to score at least 3 points on the General Health Questionnaire-12 screening tool. Symptoms had to be present for a minimum of 4 weeks but no longer than 6 months. Patients were randomi...
To estimate the economic burden of coronary heart disease in the UK using both direct and indirec... more To estimate the economic burden of coronary heart disease in the UK using both direct and indirect costs. A prevalence based approach was used to assess coronary heart disease related costs from the societal perspective. All UK residents in 1999 with coronary heart disease (ICD 9 codes 410-414 and ICD10 codes I20-I25). Direct health care costs were estimated from spending on prevention, accident and emergency care, hospital care, rehabilitation, and drug treatment. Direct non-health service costs were estimated from data on informal care. "Friction period" adjusted productivity costs were estimated using the human capital approach from lost earnings attributable to coronary heart disease related mortality and morbidity. The friction period is the period of employees' absence from work before the employer replaces them with other workers. Failure to adjust for this factor would overstate production loss. Coronary heart disease cost pound 1.73 billion to the UK health ca...
To estimate the cost effectiveness of conventional versus intensive blood glucose control in pati... more To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Incremental cost effectiveness analysis alongside randomised controlled trial. 23 UK hospital clinic based study centres. 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Incremental cost per event-free year gained within the trial period. Intensive glucose control increased trial treatment costs by pound 695 (95% confidence interval pound 555 to pound 836) per patient but reduced the cost of complications by pound 957 (pound 233 to pound 1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was pound 478 (-pound 275 to pound 1232) per patient. The within trial event-free time gained in the intensive group was...
As residential radon programmes of identification and remediation have proceeded, so questions ha... more As residential radon programmes of identification and remediation have proceeded, so questions have been raised about their costs and benefits. This study presents a generalizable model for estimating the cost-effectiveness of a radon mitigation programme using the methodological framework now considered appropriate in the economic evaluation of health interventions. Its use will help to inform future discussion of radon remediation and lung cancer prevention programmes. Data from Northamptonshire were analysed, resulting in a societal cost-effectiveness ratio of Pounds Sterling 13250 per life-year gained in 1997. The percentage of houses found to be over the action level, and the percentage of householders who decide to remediate are shown to be important parameters for the cost-effectiveness analysis. Questions are raised about the particular importance of perspective in this type of analysis and suggestions are made for future research directions.
This paper puts forward a proposal for a modelling approach to the estimation of long term cost s... more This paper puts forward a proposal for a modelling approach to the estimation of long term cost savings from the treatment of Alzheimer's disease (AD). In the proposed modelling approach, disease progression is defined in terms of intervals in the Mini-Mental State Exam (MMSE) scale. Clinical trial data are then used to determine the time at which a particular patient moved into a more severe stage of the disease. By comparing these durations across treatment groups, survival analysis is used to measure the impact of treatment in delaying the onset of a more costly stage of the disease. Patients with varying severity of AD. The model uses clinical trial data on 1333 patients recruited internationally in 2 studies from 67 centres. The aim of these clinical studies was to evaluate the safety and efficacy of 2 non-overlapping dose ranges of rivastigmine relative to placebo over a 26-week treatment period in patients with probable AD. The results indicate that the average cost savin...
Health technology assessment (Winchester, England), 1999
... Please use this identifier to cite or link to this item: http://hdl.handle.net/10068/576087. ... more ... Please use this identifier to cite or link to this item: http://hdl.handle.net/10068/576087. Title: Handling uncertainty when performing economic evalutation of healthcare interventions. Authors: Briggs, A. Gray, A. National Coordinating ...
Journal of the Royal College of Physicians of London
A random sample of 25 cardiac rehabilitation programmes in England and Wales was surveyed by ques... more A random sample of 25 cardiac rehabilitation programmes in England and Wales was surveyed by questionnaire. Using workload and resource data returned, costs were calculated per centre, per patient and per session. Sixteen (64%) of the centres returned full details. Annual staffing costs per cardiac rehabilitation centre were in the range 10,000 Pounds to 62,000 Pounds, with a mean of just under 33,0000 Pounds (median 32,000 Pounds). Mean cost per patient completing the rehabilitation programme was 370 Pounds (median 223 Pounds), and mean cost per patient per session was 47 Pounds (median 26 Pounds). There was substantial intercentre variation in costs. Cost per patient was closely related to patient throughput and hours of contact time. The costs of rehabilitation programmes in this survey exceed earlier estimates. To assess the implications for the cost-effectiveness of such programmes, reliable data on the effectiveness of such programmes are now required.
Rationale: Cerebrovascular diseases (CVD) are a major cause of death and disability. A meta-analy... more Rationale: Cerebrovascular diseases (CVD) are a major cause of death and disability. A meta-analysis found that stroke severity (p Objectives: This study assesses the impact of TIA and stroke, and their severity, by examining the predictors of QoL one-year after the event, including previous QoL, using data from a population-based study. Methodology: Data were obtained from the Oxford Vascular study (OXVASC), a population-based cohort of >90,000 individuals in Oxfordshire, UK. OXVASC identified 284 patients with a first or recurrent CVD event during April 2002, to March 2003. QoL was assessed using the EQ-5D at one-month and one-year after the index event. At one-month, patients were also asked about their QoL before the event (baseline). EQ-5D results were converted into utilities using UK social tariffs, with the analysis only considering the 217 (76%) patients who survived past one-year after event. Stepwise multivariate analyses were performed to identify predictors of one-ye...
To assess UK governmental and charity research funding in 2012 for cancer, coronary heart disease... more To assess UK governmental and charity research funding in 2012 for cancer, coronary heart disease (CHD), dementia and stroke, and to make comparisons with 2008 levels. Analysis of research expenditure. United Kingdom. We identified UK governmental agencies and charities providing health research funding to determine the 2012 levels of funding for cancer, CHD, dementia and stroke. Levels of research funding were compared to burden of disease measures, including prevalence, disability adjusted life years and economic burden. The combined research funding into cancer, CHD, dementia and stroke by governmental and charity organisations in 2012 was £856 million, of which £544 million (64%) was devoted to cancer, £166 million (19%) to CHD, £90 million (11%) to dementia and £56 million (7%) to stroke. For every £10 of health and social care costs attributable to each disease, cancer received £1.08 in research funding, CHD £0.65, stroke £0.19 and dementia £0.08. A considerable shift in the d...
This study examines national health expenditure trends for Japan, Canada, Australia, and England ... more This study examines national health expenditure trends for Japan, Canada, Australia, and England and Wales (combined) to assess the impact of changing demographics and changing age-specific per capita expenditure on national health expenditure. Age-specific expenditure data were obtained from each country's department of health. We calculated changes in age-specific per capita expenditure, population demographics and the share of expenditures used by the different age groups over time. We then determined the extent to which isolated changes in population growth, demographic shifts and changes in age-specific per capita expenditure could predict observed increases in health expenditure. For Japan, Canada and Australia per capita health expenditure increased fastest among those aged 65 and over, at up to twice the increase of those aged 45-64. In England and Wales, on the other hand, those aged 65 and over experienced one-third of the cost increase of those aged 45-64. Hence, the ...
The Journal of the Royal College of General Practitioners, 1981
The roles of general practitioner and specialist maternity units are increasingly being debated w... more The roles of general practitioner and specialist maternity units are increasingly being debated with reference to resources and the need for savings in the NHS. Unfortunately, many of the economic issues involved are frequently misunderstood. On the basis of a study of maternity care in one Health Board area in Scotland, we present an example of the type of economic data which are needed to make policy decisions on resource allocation in hospital maternity care. Differences between the two unit types are presented in terms of their unit costs, their cost structures and their inpatient cost profiles.
The increasing use of thrombolytic therapy following acute myocardial infarction has given rise t... more The increasing use of thrombolytic therapy following acute myocardial infarction has given rise to value for money questions. This study examines the cost-effectiveness of the thrombolytic agent anistreplase (Eminase). Using clinical trial data on the efficacy of anistreplase compared to placebo, and retrospectively obtained cost data from the National Health Service, the study estimates the cost per life-year saved of using this therapeutic agent. The results suggest that the cost-effectiveness of thrombolytic therapy compares favourably with that of other forms of coronary disease treatment. The study concludes that comparisons of the relative cost-effectiveness of different thrombolytic agents are an obvious next step, once full results from recent clinical trials are available.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 5, 2015
It is unclear whether a social gradient in health outcomes exists for people with moderate-to-sev... more It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the 'suitability' of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance an...
Diabetic medicine : a journal of the British Diabetic Association, 2015
To estimate the immediate and long-term inpatient and non-inpatient costs for Type 2 diabetes-rel... more To estimate the immediate and long-term inpatient and non-inpatient costs for Type 2 diabetes-related complications. The costs of all consultations, visits, admissions and procedures associated with diabetes-related complications during UK Prospective Diabetes Study post-trial monitoring in the period 1997-2007 were estimated using hospitalization records for 2791 patients in England and resource use questionnaires that were administered to 3589 patients across the UK. The estimated (95% CI) inpatient care costs (in 2012 pounds sterling) in the event year for the example of a 60-year-old man were: non-fatal ischaemic heart disease £9767 (£7038-£12 696); amputation £9546 (£6416-£13 463); non-fatal stroke £6805 (£3856-£10 278); non-fatal myocardial infarction £6379 (£4290-£8339); fatal stroke £3954 (£2012-£6428); fatal ischaemic heart disease £3766 (£746-£5512); heart failure £3191 (£1678-4903); fatal myocardial infarction £1521 (£647-£2670); and blindness in one eye £1355 (£415-£2655...
We aimed to estimate and externally validate a new UK-specific prognostic model for predicting th... more We aimed to estimate and externally validate a new UK-specific prognostic model for predicting the long-term risk of a first recurrent event (local recurrence, metastatic recurrence, or second primary breast cancer) in women diagnosed with early breast cancer. Using data on the prognostic characteristics and outcomes of 1844 women treated for early breast cancer at the Churchill Hospital in Oxford, parametric regression-based survival analysis was used to estimate a prognostic model for recurrence-free survival. The model, which incorporated established prognostic factors, was externally validated using independent data. Its performance was compared with that of the Nottingham Prognostic Index (NPI) and Adjuvant! Online. The number of positive axillary lymph nodes, tumour grade, tumour size and patient age were strong predictors of recurrence. Oestrogen receptor (ER) positivity was shown to afford a moderate protective effect. The model was able to separate patients into distinct pr...
Adjuvant! Online is an internet-based computer programme providing 10-year prognosis predictions ... more Adjuvant! Online is an internet-based computer programme providing 10-year prognosis predictions for early breast cancer patients. It was developed in the United States, has been successfully validated in Canada, and is used in the United Kingdom and elsewhere. This study investigates the performance of Adjuvant! in a cohort of patients from the United Kingdom. Data on the prognostic factors and management of 1065 women with early breast cancer diagnosed consecutively at the Churchill Hospital in Oxford between 1986 and 1996 were entered into Adjuvant! to generate predictions of overall survival (OS), breast cancer-specific survival (BCSS), and event-free survival (EFS) at 10 years. Such predictions were compared with the observed 10-year outcomes of these patients. For the whole cohort, Adjuvant! significantly overestimated OS (by 5.54%, P<0.001), BCSS (by 4.53%, P<0.001), and EFS (by 3.51%, P=0.001). For OS and BCSS, overestimation persisted across most demographic, patholog...
Health technology assessment (Winchester, England), 2005
To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic ... more To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic CMHN care, against usual general practitioner (GP) care in reducing symptoms, alleviating problems, and improving social functioning and quality of life for people living in the community with common mental disorders; and to undertake a cost comparison of each CMHN treatment compared with usual GP care. A pragmatic, randomised controlled trial with three arms: CMHN problem-solving, generic CMHN care and usual GP care. General practices in two southern English counties were included in the study. CMHNs were employed by local NHS trusts providing community mental health services. Participants were GP patients aged 18--65 years with a new episode of anxiety, depression or reaction to life difficulties and had to score at least 3 points on the General Health Questionnaire-12 screening tool. Symptoms had to be present for a minimum of 4 weeks but no longer than 6 months. Patients were randomi...
To estimate the economic burden of coronary heart disease in the UK using both direct and indirec... more To estimate the economic burden of coronary heart disease in the UK using both direct and indirect costs. A prevalence based approach was used to assess coronary heart disease related costs from the societal perspective. All UK residents in 1999 with coronary heart disease (ICD 9 codes 410-414 and ICD10 codes I20-I25). Direct health care costs were estimated from spending on prevention, accident and emergency care, hospital care, rehabilitation, and drug treatment. Direct non-health service costs were estimated from data on informal care. "Friction period" adjusted productivity costs were estimated using the human capital approach from lost earnings attributable to coronary heart disease related mortality and morbidity. The friction period is the period of employees' absence from work before the employer replaces them with other workers. Failure to adjust for this factor would overstate production loss. Coronary heart disease cost pound 1.73 billion to the UK health ca...
To estimate the cost effectiveness of conventional versus intensive blood glucose control in pati... more To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Incremental cost effectiveness analysis alongside randomised controlled trial. 23 UK hospital clinic based study centres. 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Incremental cost per event-free year gained within the trial period. Intensive glucose control increased trial treatment costs by pound 695 (95% confidence interval pound 555 to pound 836) per patient but reduced the cost of complications by pound 957 (pound 233 to pound 1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was pound 478 (-pound 275 to pound 1232) per patient. The within trial event-free time gained in the intensive group was...
As residential radon programmes of identification and remediation have proceeded, so questions ha... more As residential radon programmes of identification and remediation have proceeded, so questions have been raised about their costs and benefits. This study presents a generalizable model for estimating the cost-effectiveness of a radon mitigation programme using the methodological framework now considered appropriate in the economic evaluation of health interventions. Its use will help to inform future discussion of radon remediation and lung cancer prevention programmes. Data from Northamptonshire were analysed, resulting in a societal cost-effectiveness ratio of Pounds Sterling 13250 per life-year gained in 1997. The percentage of houses found to be over the action level, and the percentage of householders who decide to remediate are shown to be important parameters for the cost-effectiveness analysis. Questions are raised about the particular importance of perspective in this type of analysis and suggestions are made for future research directions.
This paper puts forward a proposal for a modelling approach to the estimation of long term cost s... more This paper puts forward a proposal for a modelling approach to the estimation of long term cost savings from the treatment of Alzheimer's disease (AD). In the proposed modelling approach, disease progression is defined in terms of intervals in the Mini-Mental State Exam (MMSE) scale. Clinical trial data are then used to determine the time at which a particular patient moved into a more severe stage of the disease. By comparing these durations across treatment groups, survival analysis is used to measure the impact of treatment in delaying the onset of a more costly stage of the disease. Patients with varying severity of AD. The model uses clinical trial data on 1333 patients recruited internationally in 2 studies from 67 centres. The aim of these clinical studies was to evaluate the safety and efficacy of 2 non-overlapping dose ranges of rivastigmine relative to placebo over a 26-week treatment period in patients with probable AD. The results indicate that the average cost savin...
Health technology assessment (Winchester, England), 1999
... Please use this identifier to cite or link to this item: http://hdl.handle.net/10068/576087. ... more ... Please use this identifier to cite or link to this item: http://hdl.handle.net/10068/576087. Title: Handling uncertainty when performing economic evalutation of healthcare interventions. Authors: Briggs, A. Gray, A. National Coordinating ...
Journal of the Royal College of Physicians of London
A random sample of 25 cardiac rehabilitation programmes in England and Wales was surveyed by ques... more A random sample of 25 cardiac rehabilitation programmes in England and Wales was surveyed by questionnaire. Using workload and resource data returned, costs were calculated per centre, per patient and per session. Sixteen (64%) of the centres returned full details. Annual staffing costs per cardiac rehabilitation centre were in the range 10,000 Pounds to 62,000 Pounds, with a mean of just under 33,0000 Pounds (median 32,000 Pounds). Mean cost per patient completing the rehabilitation programme was 370 Pounds (median 223 Pounds), and mean cost per patient per session was 47 Pounds (median 26 Pounds). There was substantial intercentre variation in costs. Cost per patient was closely related to patient throughput and hours of contact time. The costs of rehabilitation programmes in this survey exceed earlier estimates. To assess the implications for the cost-effectiveness of such programmes, reliable data on the effectiveness of such programmes are now required.
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Papers by Alastair Gray